Objective: The contribution of stress to the aetiology of Graves' disease (GD) remains controversial. We have therefore examined life events, daily stress and coping in patients with this disease. We wished to determine whether the clinical presentation of Graves' hyperthyroidism is associated with preceding stressful events.
Design: A prospective controlled study. Ninety-five patients with newly diagnosed GD were compared to matched controls.
Method: A self-reporting questionnaire recalling life events, daily stress and coping in the twelve months preceding the diagnosis.
Result: More Graves' disease patients than controls reported negative events (P < 0.0005), whereas the number of subjects reporting positive events and neutral events were similar in both groups. Graves' disease patients also experienced more negative events (P < 0.0001) and perceived them with higher ratings (P < 0.0001). Each group had similar coping ability in terms of the number of coping methods and magnitude of utilization of these methods. Similarly, Graves' disease patients reported more daily hassle (P < 0.001) and had higher hassle scores (P < 0.001).
Conclusion: Patients with Graves' disease experienced greater psychological stress and adverse events prior to the onset of the disease. As stress may alter the immune system, it could play an important role in precipitating the disease in subjects predisposed to autoimmune thyroid disorders.